New surgical modification of fascial closure following endovascular aortic pathology repair.

Abstract

IntroductionThere are clear benefits of percutaneous versus open femoral access for endovascular aortic pathology repair. All closing devices commercially available are expensive. Surgical closure of the femoral artery risks potential prolonged wound healing and as a consequence longer hospital stay. Fascial closure is a technique that remains an interesting option.AimTo evaluate the efficacy of the surgical modification of hemostasis control after endovascular repair of aortic pathology.Material and methodsOne hundred sixteen common femoral arteries in a group of 58 patients underwent a minimally invasive procedure. Patients suffering from abdominal, thoracic aorta aneurysms, acute thoracic aorta type B dissections and traumatic aortic injury were treated.ResultsA 1-year period of experience in fascial closure of 116 common femoral arteries was presented in the group of 58 patients undergoing endovascular interventions. Five intraoperative complications were observed and one late. Three primary failures were due to hemorrhage in three arteries, one required open repair and two additional compression after the procedure. Two cases of limb ischemia required surgical correction of artery closure. One limb ischemia was detected 4 weeks later, and was treated conservatively. At 1 year, 92 fascial closures (80%) were in the follow-up and 24 (20%) were lost to follow-up.ConclusionsThis new modification of fascial closure is a safe and cheap method of arterial closure following endovascular repair of selected aortic pathologies. The usage of two suture lines makes this procedure easy and quick. Fascial closure technique is comparable to other techniques in terms of success and complication rates.

Fascia Suture Technique and Suture-mediated Closure Devices: Systematic Review

“…It is worth mentioning that in these later studies, plaque/calcification did not appear to influence the success of fascia closure, as it was reported with the SMCD. [23][24][25][26][27] A new attempt to evaluate the technical success was made by Dziekiewicz et al 50 In this study, 58 patients (116 CFA) were included, whose CFA were detected preoperatively using a CTA. Recently, we published our experience with the results to be acceptable.…”

“…On the other hand, in the FST group, technical success was defined as the achievement of hemostasis with adequate distal perfusion within the first 24 hours without femoral occlusion or use of additional fascial sutures. 15,[46][47][48][49][50] Any complication (bleeding and/or thrombosis) that leads to additional procedure within 24 hours was classified as intraoperative complication, whereas complications, such as bleeding, thrombosis, pseudoaneurysm, stenosis, neuralgia, seroma, and local infection, that took place after 24 hours were considered postoperative.…”

“…2 PDS absorbable suture) on both sites of the lumen of the introducer, as it was recently described. 50 Subsequently, the sutures are tightened with simultaneous withdrawal of the introducer. When hemostasis is achieved, the guidewire is removed, and the sutures are further tightened.…”

“…The effectiveness of the Proglide system was evaluated in four studies, 18,28,29,42 whereas the outcomes of the two SMCDs were compared and described in two studies. 27,29 On the other hand, all six studies 15,[47][48][49][50][51] referring to FST were non-randomized trials and did not include a control group with groin dissection for comparison. Recently, one RCT study investigated whether the FST can reduce the access closure time and the procedural costs compared with the Prostar XL technique in patients (n ¼ 100) undergoing EVAR.…”

Analysis of patients with thoracic aortic aneurysm taking into account risk factors, procedure and prognosis in 5-year clinical observation

“…Warto wspomnieć o badaniach Dziekiewicza i wsp. [23] obejmujących 58 pacjentów z tętniakami aorty. Zwrócono uwagę na przewagę leczenia przezskórnego nad konwencjonalnymi metodami operacyjnymi.…”